[Alcohol, protective or risk factor for cardiovascular disease ?]

Alcohol may exert both positive and negative effects on cardiovascular system. Several factors may modulate these effects, among which, most importantly, the daily dose but also consumption modalities (type of beverage, regular or hectic consumption, for instance). Many epidemiological studies showed a J curve, with a greater risk of cardiovascular disease in non-consumers compared with light to moderate regular drinkers, but with a higher risk in heavy drinkers, in a dose-dependent manner. This article analyses the complex relationships between alcohol consumption and the risk of coronary and cerebrovascular diseases, including cardiovascular mortality. Owing to the remaining uncertainties, in absence of controlled trials, and the difficulty not to overcome the positive threshold, it is not currently recommended to drink alcohol in order to benefit of a cardiovascular protection.

[Cardiovascular effects of alcohol consumption]

Alcohol consumption is a serious problem in terms of public health because it remains a major cause of illness and premature death. The effects of alcohol on cardiovascular system are particularly complex. Current data report both favourable and adverse effects depending on the level of consumption, the type of alcohol consumed and the pathology considered. The goal of this review is to describe the spectrum of cardiovascular events associated with alcohol consumption.

[Alcoholic hepatitis]

Alcoholic hepatitis is a syndrome defined primarily by the clinical onset of jaundice in patients with a concomitant heavy consumption of alcoholic beverages. This pathology is managed by alcohol withdrawal with a 30-day survival rate of 90 %. For patients with severe alcoholic hepatitis, with a Maddrey score greater than 32 (taking into account bilirubin and prothrombin time), treatment with corticosteroids is discussed provided that a possible infection can be sufficiently excluded or adequately managed. The administration of corticosteroids is continued for 28 days if the Lille score, calculated after 7 days of treatment, is favourable (inferior to 0.45), leading to a survival rate of 80-90 %. However, if the Lille score is unfavourable (superior to 0.45), the prognosis is bad, with a survival of only 25-30 % at 6 months. Special attention needs to be paid to assure a sufficient caloric intake during the treatment period for a successful management. Liver transplantation, previously prohibited for this indication, can be discussed under certain circumstances. However, the success of treatment is contingent upon the alcohol withdrawal. Innovative drugs are currently under investigation to improve the prognosis of this condition.

[Alcohol consumption and head and neck cancer]

Alcohol is often considered as a simple co-factor, potentiating the carcinogenic effect of tobacco, in head and neck cancer. However, its own effect is less clear. It has been recognized by the International Agency for Research on Cancer (IARC) as a risk factor for head and neck cancer for many years. It seems that the risk is a function of the importance of consumption, with certain genetic predispositions. This risk can also decrease if consumption stops, with a prolonged interruption. In addition, alcohol consumption may have a negative influence on the prognosis of patients with this type of cancer. A preventive action is therefore essential, among other things via information to the patient provided by health providers.

[Alcohol, pregnancy and breast-feeding]

Perinatal studies over the last ten years report that 3 % of pregnant women have alcohol consumption. The malformative and neurological consequences of prenatal exposure to alcohol have been known for more than 50 years. Research has shown that the effects of alcohol during pregnancy and breast-feeding go far beyond visible abnormalities at birth. Neurological consequences, from minor psychomotor retardation to severe behavioural disorders, make all the severity of this intoxication and justify strict instructions to refrain from taking alcohol during pregnancy and breast-feeding.

[Alcohol consumption in teenagers : binge drinking]

Binge drinking has become a common practice among teenagers, thus a banal behaviour in parties. It is part of a normal psychological evolution that pushes the young to confront limits, prohibitions, other peers, and even more to confront himself. The festive dimension further reinforces this attraction for group transgression. Yet neuroscientific studies are unanimous in showing the negative effects of binge drinking on a maturing brain, with significant neurocognitive and even neuroanatomical alterations. It is illustrated by research conducted on humans and on animal models. This article aims to show the difficult articulation between a clinical practice open to young people and a necessary concern about their behaviour, the danger of which they usually do not know.

[Alcohol and car driving]

Alcohol intoxication during car driving represents a well-recognized danger and is responsible for numerous accidents leading to premature death or infirmities. The objectives of this article are to describe some epidemiological data about driving under alcohol influence and associated car accidents, to remind which alcohol blood concentrations are acceptable from a legal point of view, to analyse the acute effects of alcohol on cortical function that could alter driving capacities and, finally, to consider some conditions that may reduce or increase the effects of alcohol on the performances during car driving. Keywords : Alcohol - Car accident - Driving - Brain.

[Alcohol and the skin]

Cutaneous manifestations related to alcohol intake and abuse are various. Most frequently, there are vascular lesions and cutaneous alterations secondary to hepatic dysfunction. Alcohol consumption represents also a risk factor for many cutaneous diseases, such as psoriasis, where its prevalence is high. Other cutaneous complications associated with alcohol are also discussed.

[Metabolic complications and nutritional deficiencies related to excessive alcohol consumption]

Metabolic disturbances associated with chronic alcohol consumption, among which those affecting glucose regulation, lipid profile, uric acid and nutritional status, are described. In fact, alcohol abuse can lead to overweight and obesity, but also to protein-caloric malnutrition. Finally, we will discuss concerns about vitamin and mineral deficiencies that may be observed in alcoholic people and can contribute to aggravate somatic complications.